12 / 34
10
11% in Hispanics and Latinos.
17
Of those who reported musculoskeletal conditions, activity limitation was reported in 36%
of Caucasians, 45% of African Americans and 43% of Hispanics and Latinos. Both work limitations and severe pain were
significantly higher among Hispanics/Latinos and African Americans, compared to non-Hispanic white people.
17
Statistically, Caucasians demonstrate the highest prevalence of musculoskeletal conditions, yet the ethnic minorities
experience greater pain and impact on mobility and activities of daily living. Ethnic minorities also experience higher
comorbidities, such as obesity, cardiovascular disease and diabetes than Caucasians.
Musculoskeletal pathology and comorbidities found in ethnic minorities reflect
health and treatment disparities, which may be a result of several factors
including socioeconomic status, inadequate access to care and quality of care.
Findings of various studies suggest that efforts by healthcare providers to
identify and manage comorbidities (eg, obesity, diabetes) could directly impact
the prevalence of musculoskeletal disorders in these groups.
Multi-ethnic studies on the prevalence of musculoskeletal disorders in women have been quite revealing. The Women’s
Health Initiative (WHI) conducted an analysis published in 2008 that assessed risk factors for self-reported osteoarthritis
in an ethnically diverse cohort of women. The participants were postmenopausal women aged 50 to 79 (n=146,494). The
results from the group’s analysis showed, as had many studies previously, that race, age, and body mass index (BMI) were
confirmed as risk factors for osteoarthritis. In women age 60 and above, African American and Hispanic/Latina women were
more likely to develop osteoarthritis than Caucasian American women. Overall, the prevalence of OA increased with age. In
this category, the prevalence of obesity (defined as BMI greater than or equal to 30) was highest in African American women
and lowest in Caucasian women.
18
In another study presented at the 2012 annual meeting of the American College of Rheumatology, African American women
had the highest risk of developing knee OA, with Hispanic women being second highest. Their findings were attributed to
African American and Hispanic women having higher instances of being overweight, a major risk factor for developing knee
OA that is consistent with the majority of studies in this area.
19
THE INFLUENCE OF ETHNICITY AND PAIN
In a population-based survey by Reyes-Gibby,
et.al., 27% of African Americans and 28% of Hispanics over the age of 50
reported having severe pain most of the time; only 17% of non-Hispanic whites did.
20
African Americans were found to have
lower pain thresholds than Caucasian Americans. They were also more likely than non-Hispanic whites to underreport
pain unpleasantness in the clinical setting, especially in the presence of physicians who were perceived as having “higher
social status”.
21
African Americans were more likely to attribute pain to personal inadequacies and to use “passive” coping
strategies, such as prayer.
21
Compared to Caucasians, African Americans and Hispanic/Latino Americans were more afraid of opioid addiction, and
were less likely to misuse prescription opioids. African Americans and Hispanic/Latino Americans were less likely than
Caucasians to receive any pain medication and more likely to receive lower doses of pain medication, despite higher pain
scores. Several studies of patients with lower back pain found that African Americans reported greater pain and higher
levels of disability than Caucasians, but were rated by their clinicians as having less
severe pain.
21
These findings suggest that clinicians incorrectly, and possibly unconsciously, believe that Hispanic/Latino American and